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Leveraging Blockchain to Transform Clinical Credentialing
Session 280, February 14, 2019
Anthony D. Begando, CEO & Co-Founder
Professional Credentials Exchange
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Anthony D. Begando has no real or apparent conflicts of interest to
report.
Conflict of Interest
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• Introduce Credentialing Generally and Discuss the Challenges
Facing the Healthcare Industry
• Provide a brief overview of the ProCredEx platform and the
challenges addressed in its development
• Review the current state of Blockchain / Distributed Ledger
Technology (DLT) and how it is utilized within the ProCredEx
architecture
• Discuss the importance of scale within a marketplace application
• Provide a brief demonstration of how ProCredEx transforms
credentials data collection and verification
Agenda
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• Identify the intrinsic complexities existing within the clinical
credentials dataset
• Recognize the contextual variations that exist between healthcare
organizations in interpreting credentials data and related artifacts
• Explain how blockchain technology addresses gaps in trust
between transactional counterparties
• Differentiate the various forms of blockchain protocols, permission
architectures, and consensus algorithms available for applications
seeking to leverage distributed ledger technology
• Explain the importance of forming a minimum viable network in
developing blockchain-based solutions
Learning Objectives
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• The process of gathering and verifying the data and artifacts
needed to confirm the professional competency of an individual to
perform a specific occupation within a specific setting
• Applies to numerous industries:
– Healthcare
– Financial Services & Accounting
– Aviation
– Architecture & Engineering
– Construction
– Public Safety
What is Credentialing?
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• Mandated, perpetual process confirming the
clinical competency of healthcare professionals
• Must be performed by any organization
delivering or paying for patient care
• Applies to virtually all 13.6 million care delivery
personnel
• Physician / Hospital / Payer Use Case
o 4 - 6+ month process
o Costs $300 - $1,500+ / episode
o $7,500 daily net revenue forfeitures*
o 200MM+ annual artifact transactions
• Payers spending $2.2BN annually to maintain
provider data
Challenges Facing Healthcare Credentialing
* Source: Merritt Hawkins 2016 Inpatient/Outpatient Revenue Survey
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Metric
Value
Number of Credentialed Physicians
600
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
Retroactive Payer Reimbursement Allowance (CMS,
Medicaid)
20%
Retroactive Payer Reimbursements
($160,500.00)
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
Retroactive Payer Reimbursement Allowance (CMS,
Medicaid)
20%
Retroactive Payer Reimbursements
($160,500.00)
Total Net Revenue Forfeiture During Onboarding
$642,000.00
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
Retroactive Payer Reimbursement Allowance (CMS,
Medicaid)
20%
Retroactive Payer Reimbursements
($160,500.00)
Total Net Revenue Forfeiture During Onboarding
$642,000.00
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
Retroactive Payer Reimbursement Allowance (CMS,
Medicaid)
20%
Retroactive Payer Reimbursements
($160,500.00)
Total Net Revenue Forfeiture During Onboarding
$642,000.00
Aggregate Annual Forfeited Net Revenue
$46,224,000.00
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Industry-wide Impact
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• Reduced Onboarding/Enrollment Cycle Time
• Simplified Practitioner Engagement
• Significant Reduction in Revenue Forfeitures
• Lowered Administrative Costs & Burdens
• Recognition of Investments in Time & Effort
• Continuous Maintenance & Risk Mitigation
• Occupationally Agnostic
Market Objectives
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Complex Data
• Inherently Unstructured
• No Standards
• Unique Attributes
• Unlimited Types
• Doesn’t “Fit” into Traditional
Databases
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Organizational Context
Wellingud Health SystemWellingud Health System
✅ Rules
🔃 Processes
📝 Requirements
📑 Forms
💾 Data
• Established Systems
& Processes
• Bylaw & Policy Driven
• Aligned with
Operational
Requirements
• Unique Interpretation
of Data and Artifacts
• Exceptionally
Difficult to Change
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Complex Analytics
• Reliant on Individual
Empirical Knowledge & Experience
• Complex Rules
• Expensive & Inefficient
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Lack of Trust Between Constituents
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Creates Widespread Redundancy
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Simplifying Complexity
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Recognizing Value
Portfolio Artifacts
Delineation of
Privileges
Artifact Verifications
St. Mary’s Hospital
Document
Image
Artifact
Metadata
Verification
• Verification Details
• Verification Resource
• Verification Method
• Verification Outcome
• Asset Stake
• Verification Details
• Verification Resource
• Verification Method
• Verification Outcome
• Asset Stake
Eastside Hospital
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• Open Source vs. .Net
• Transaction Payloads & Data
Management
• DLT Protocol Performance
• UX & Device Considerations
• API Connectivity
• HIPAA / HITECH
Bottom Line:
• Current
• Relevant
• Massively Scalable
• Compliant & Secure
Architectural Considerations
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• Confirms the origin, data, and history of an asset
with exceptionally high reliability
• Moves trust to the software and disambiguates
centralized control of information
• Maturing into purpose-built, enterprise level
solutions
– Generation 1 -- BitCoin
– Generation 2 – Ethereum, Hyperledger et al.
– Generation 3 – R3/Corda, Digital Asset
• Practitioner identity and credentialing represent
an ideal early adoption use case for the industry
Why Blockchain / DLT?
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Privacy
Security
Performance
Tokenization vs. Fiat Currency Transactions
Consensus Algorithms & Deployment Realities
DLT Considerations
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• Digital Asset’s DAML Protocol
– Permissioned
– Confidential
– Industry-level Performance
– Massively Scalable
– Developed Specifically for
Markets and Exchanges
– Simplified Smart Contract
Development
Protocol & Use Case Alignment
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Success = Model Convergence
Business Model
Technical Model
Network
Governance
Model
Finding this is hard
(but your future may depend on it)
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Participants
Delivery Members
Payer Members
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Consolidate
management of
credentials with
business partners
•
Reduce administrative
costs and burdens
• Align business partners
with portfolio changes
•
Enhance mobility and
reach with new
business partners
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Increase revenue by
reducing onboarding
cycle time
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Reduce cost and
complexity
•
Improve practitioner
engagement
• Simplify recredentialing
and reappointment
processes
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Maintain perpetual
alignment with
practitioner data
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Substantially reduce
costs associated with
provider data
management
• Simplify enrollment and
reenrollment cycle
times
•
Maintain perpetual
alignment with
practitioner data
•
Reduce fines
associated with
directory data
misalignment
Incentive Alignment
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• Markets Must Emerge With Significant Supply of Data and
Verification Assets
• Significant Scale Achieved Through:
– Recruitment of National Payers and Super-Regional
Healthcare Firms
– Integration With Existing Data Aggregators & Software Firms
– Developing Implementation Partners to Drive Scalability
– Creating Financial Incentives For Early Adoption
– Member Diversity
• Minimized Disruption of Existing Business Processes
• Create Incentives for Collaboration in Light of Competition
Creating a Minimum Viable Network
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• Ideate with Key Market Influencers to Ensure Market/Product Fit
• Most Solutions Require Significant Networks and Diverse
Participation to Align Members
• Build Early Prototypes to Visualize Value Proposition & Engender
Support
• Balance Architectural Ideals with Real-World Deployment
Realities
• Create Governance Models Led By Network Members
• Involve Network Members In All Phases of Solution Development,
Testing, Piloting, & Commercial Deployment
• Create Realistic Capital Requirements & Target Strategic Sources
Deployment Best Practices
